A retrospective analysis of 122 deaths caused by vest and strap restraints found that most victims were women (78%) and a median age of 81. Victims were found suspended from chairs (42%) or beds (58%); 83% were in nursing homes. Detailed analysis of 19 cases showed that all were demented, 13 had impulsive or involuntary movements, and 14 had recently tried to escape from a restraint or been found in a dangerous position while restrained. Restraints are an underrecognized, underreported, avoidable, and proximate cause of at least 1 of every 1,000 nursing home deaths.